Strong on the Outside, Struggling Inside: Men’s Mental Health

Maybe nothing has completely fallen apart. You are still going to work, taking care of things at home, showing up for people, and getting through the week. But perhaps you have noticed that you are more on edge than you used to be. Maybe you are checking out more, getting frustrated more easily, losing interest in things, or just feeling like something has been off for a while.

Or maybe you are reading this because somebody else thinks something is off.

Some of the men I meet come to counselling because a partner has been worried about them, a doctor suggested it, or something at home or work has become difficult enough that ignoring it is getting harder. Sometimes they are not particularly convinced that counselling is going to help.

You do not need to be convinced before you come in. You can use the first conversation to find out what counselling is actually like and whether any of it makes sense to you. Whatever got you through the door, the conversation is still yours.

What Happens in Your First Counselling Session?

One thing I have noticed with people who have never been to counselling before is that there can be some uncertainty about the rules.

What am I supposed to talk about? How much do I have to tell you? Are you going to analyze everything I say? What if I do not know where to start?

Those are fair questions.

A first session is usually fairly straightforward. I will want to know what has been happening lately and what led you to make the appointment. I will probably ask what you would like to be different, although "I'm not really sure yet" is a perfectly workable answer.

There will be some ordinary questions as well. Depending on what brought you in, I may ask about things like sleep, stress, relationships, work, alcohol or other substance use, your health, and whether there are any concerns about your safety. I am not looking for everything that might be wrong with you. I am trying to get enough of the picture to understand what you are dealing with and how we can work safely.

I will also explain confidentiality and its limits, talk a little about how I work, and give you time to ask questions.

You do not need to tell me your whole life story in the first hour. You also do not automatically have to start talking about your childhood because you walked into a counsellor's office. Sometimes the past becomes useful because it helps us understand something that keeps happening today. Sometimes the work stays much more focused on what is happening in your life right now.

If I ask about something and you are not ready to get into it, you can tell me. You can also ask why I am asking, disagree with something I suggest, or tell me when something we are trying is not useful. I would rather know that than have you sit there politely thinking the whole thing is ridiculous.

Counselling works best as a conversation we are having together, not something I am doing to you.

Do I Have to Sit Around Talking About Feelings?

Maybe. But probably not in the way you are imagining.

Feelings are sometimes part of counselling because they can tell us something important about what is happening. You do not need a sophisticated emotional vocabulary to do this well, though. "I'm pissed off," "I don't know," "I feel nothing," or "I just want this situation to stop" all give us somewhere to begin.

Some sessions can be very practical. If your temper has started causing problems, we might look closely at what happens before you lose it. What tends to set things off? What do you notice in your body? What thoughts show up? At what point do you stop having much choice about how you respond?

If the same conversation with your partner keeps going badly, we can look at that pattern. If anxiety has you constantly anticipating problems or replaying conversations, we can figure out what keeps that going and what might help. If you are drinking more than you want to, withdrawing from people, struggling with motivation, grieving someone, feeling distant from your kids, or wondering what happened to the person you used to be, those are all things we can talk about too.

Sometimes there is not a clear problem to solve. You just know life does not feel quite right anymore.

Those conversations can move into bigger questions as well. What matters to you now? Does the life you have still fit the person you want to be? There is room for that in counselling too, but we do not have to force those questions before they are useful.

Being Strong Is Not the Problem

I think this is worth saying because discussions about men's mental health can sometimes make it sound as though independence, toughness, privacy, or self-reliance are somehow problems that therapy needs to correct.

I do not see it that way.

Being dependable, steady under pressure, willing to take responsibility, and capable of handling difficult things can be real strengths. I have no interest in talking you out of qualities you value in yourself.

What is worth looking at is whether a way of coping that has served you well is starting to cost you something.

Putting things aside can be useful. Sometimes that is exactly what allows someone to get through a difficult shift, deal with an emergency, take care of their family, or simply make it through a hard week. The trouble is that putting something aside is not always the same as dealing with it.

You might notice the strain somewhere else. Perhaps you are more irritable than you used to be, have trouble switching off at night, spend more time alone, work longer hours, drink more, disappear into your phone or gaming, or have less interest in things you normally enjoy.

None of those things automatically means there is a mental health disorder. There can be many reasons our habits or moods change. What matters is noticing when something has shifted and becoming curious about what might be behind it.

For some men, still being able to function makes it harder to decide whether what they are dealing with is serious enough to talk about. If you are still working, paying the bills, and getting things done, it can be easy to think you should just keep going.

There is no requirement that things become unbearable first.

There Is No One Way to Be a Man

Men are not all struggling with the same things, and there is no single male way of dealing with stress.

Some men are very comfortable talking about how they feel. Others are not. Some want strategies almost immediately. Others have been thinking deeply about their lives for years before they ever sit down with a counsellor.

Culture, age, sexuality, family expectations, work, faith, health, and previous experiences with health care can all affect how someone thinks about asking for help. So can personality. Some people are simply private.

My job is not to decide what kind of person, or what kind of man, you should become. I want to understand what you think needs attention and what you would like to be different.

Sometimes the first answer is, "Honestly, I don't know. My wife told me I should come."

We can work with that.

What If Someone Else Wants Me in Counselling?

This happens often enough that I think it deserves its own conversation.

Maybe your partner is the one who found the counsellor. Maybe your doctor has been bringing it up for months. Perhaps somebody close to you has told you that your anger, drinking, anxiety, withdrawal, or mood is affecting them.

You may agree with them completely. You might agree with part of it. You might think they have misunderstood what is happening.

A partner can have a legitimate reason to be worried and you can still have your own understanding of what is going on. Those things do not cancel each other out.

I want to know what you think needs attention. If you decide your partner has a point, we can work with that. If you see things differently, that is something we can explore as well.

The person who encouraged you to make the appointment does not get to send instructions along with you. Counselling is not a place where I decide who was right in an argument or convince you to become the person somebody else wants you to be.

It is a place where we can try to understand what has been happening and what you want to do about it.

If You Are Encouraging Him to Try Counselling

You may be reading this because you care about someone and have been watching him struggle. You might be worried, but you may also be frustrated, exhausted, hurt, or angry about what has been happening.

Those feelings matter too.

Supporting someone does not mean pretending their behaviour has not affected you. If his temper has frightened you, his drinking is creating problems, or his withdrawal has left you feeling alone in the relationship, you are allowed to be clear about your own experience and what you need.

What tends to be less useful is trying to diagnose him or decide in advance what counselling needs to fix.

Instead of "You need therapy," you might say, "You haven't seemed like yourself lately and I'm worried about you," or "Things have been hard between us and I think we might need some help figuring out what is happening."

You can offer practical help too. You might help look at counsellor profiles, pass along information, or help make space in the schedule for an appointment. But once he is sitting in the counselling room, the work needs to become his.

The counsellor is not there to report back to you or prove that you were right. Giving him some ownership of the process may actually make it easier for him to be honest about what is going on.

You Can Find Out What You Think

You do not have to decide in advance that you are a "therapy person." You also do not have to know exactly what you want to work on.

The first meeting gives you a chance to get a sense of the counsellor too. Do you feel reasonably comfortable talking with them? Does their way of working make sense? Can you ask questions? Do they seem interested in your understanding of the problem, or are they trying to fit you into theirs?

You are not signing up for counselling forever because you attended one appointment.

Sometimes the first step is simply finding out what it is actually like.

Counselling for Men in Duncan, BC and Online

At Moxie Health & Wellness in Duncan, BC, I work with men who are trying to understand what has been happening in their lives and decide what they want to do next. Sometimes there is a clear issue to work on. Sometimes the starting point is simply, "Something has been off for a while."

Counselling with me is available in person in Duncan for men across the Cowichan Valley, and online across British Columbia.

You do not need to have the rest figured out before you arrive. If you would like to see what it is like, you can book a free consultation to start.